Clinical Journal of Gastroenterology最新文献

{"title":"Colonic metastasis of dermatofibrosarcoma protuberans detected by colonoscopy.","authors":"Takahito Shimada, Jun Takada, Kiichi Otani, Kazuki Yamauchi, Natsuko Suzui, Masahito Shimizu","doi":"10.1007/s12328-026-02384-3","DOIUrl":"10.1007/s12328-026-02384-3","url":null,"abstract":"<p><p>Colonic metastasis from dermatofibrosarcoma protuberans (DFSP) is exceedingly rare, and few reports have described its characteristic endoscopic features. Here, we report the case of a 66 year-old woman with a history of DFSP who presented with a colonic lesion detected during colonoscopy. The lesion appeared as a firm, subpedunculated, elevated mass in the descending colon. At the initial examination, the lesion was covered with intact epithelium; however, at a follow-up examination 6 weeks later, the surface epithelium had sloughed off. Endoscopic ultrasonography revealed a predominantly submucosal nodule. Endoscopic mucosal resection yielded sufficient tissue to establish a definitive diagnosis of metastatic DFSP. This case highlights not only the exceptional rarity of colonic metastasis from DFSP but also the diagnostic value of careful endoscopic evaluation-including the observation of dynamic changes in lesion morphology-as well as the role of endoscopic resection in obtaining adequate diagnostic tissue.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1044-1047"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copper-deficiency anemia and neutropenia during zinc maintenance therapy for Wilson disease associated with persistent strict dietary copper restriction.","authors":"Takako Nomura, Kiyoyuki Kobayashi, Maiko Murakami, Asaki Ichikawa, Yudai Sato, Maki Ayaki, Tomohiro Ogi, Kayo Ishikawa, Asahiro Morishita, Hideki Kobara","doi":"10.1007/s12328-026-02391-4","DOIUrl":"10.1007/s12328-026-02391-4","url":null,"abstract":"<p><p>Zinc acetate is an established maintenance therapy for Wilson disease as it reduces intestinal copper absorption. However, excessive dietary copper restriction during zinc therapy may contribute to clinically significant copper deficiency. We report a case of copper-deficiency anemia and neutropenia in a woman in her 60s with Wilson disease, hepatic and neurological involvement, and cirrhosis. Three years after transitioning to zinc maintenance therapy, leukopenia and neutropenia reappeared, followed by macrocytosis, and anemia rapidly worsened. At presentation, the neutrophil count was 378/µL, mean corpuscular volume 120.9 fL, and hemoglobin 4.4 g/dL. On detailed dietary history, persistent strict dietary copper restriction was identified, including long-term avoidance of copper-rich foods. After discontinuation of strict copper restriction, red blood cell transfusion, and zinc acetate reduction from 150 to 100 mg/day, hemoglobin stabilized at approximately 10 g/dL, neutropenia improved, and macrocytosis resolved. This case highlights that cytopenia during zinc maintenance therapy for Wilson disease should not be attributed solely to hypersplenism and that dietary practices should be reassessed because persistent strict dietary copper restriction may contribute to iatrogenic copper deficiency.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1235-1240"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic juice CEA during SPACE for pancreatic duct stenosis: diagnostic and exploratory risk stratification value.","authors":"Tetsuya Okuwaki, Shinichi Takano, Satoshi Kawakami, Natsuhiko Kuratomi, Dai Yoshimura, Koji Yamashita, Makoto Kadokura, Mitsuharu Fukasawa, Hiroko Shindo, Shinya Maekawa, Nobuyuki Enomoto, Atsunori Tsuchiya","doi":"10.1007/s12328-026-02393-2","DOIUrl":"10.1007/s12328-026-02393-2","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated whether pancreatic juice carcinoembryonic antigen (PJ-CEA) measurement during serial pancreatic juice aspiration cytologic examination (SPACE) enhanced diagnostic accuracy and was associated with subsequent pancreatic cancer (PC) diagnosis, especially in cytology-negative patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 206 patients undergoing both SPACE and PJ-CEA testing. Patients were classified into definitive diagnosis (intraductal papillary mucinous neoplasm [IPMN], non-malignant controls, or PC) and non-definitive diagnosis groups. Because PJ-CEA may be elevated in IPMN regardless of malignant potential, the cutoff for distinguishing PC from non-malignant controls was determined by ROC analysis after excluding IPMN cases from the definitive diagnosis group. Diagnostic performance was compared for SPACE alone, PJ-CEA alone, and their combination. In the non-definitive diagnosis group, cumulative PC incidence was compared between high and low PJ-CEA subgroups using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The optimal PJ-CEA cutoff was 7.9 ng/mL (AUC 0.924). In the definitive diagnosis group, sensitivity increased from 51.2% with SPACE alone to 86.0% when combined with PJ-CEA (p < 0.001). In the non-definitive diagnosis group, elevated PJ-CEA (≥ 7.9 ng/mL) was associated with subsequent PC (HR 11.7, p = 0.025), with a higher cumulative incidence in the high PJ-CEA subgroup (p = 0.019). These findings are based on a limited number of events and should be interpreted as exploratory, requiring external validation.</p><p><strong>Conclusions: </strong>After excluding radiologically identifiable IPMN, PJ-CEA measurement during SPACE may improve diagnostic sensitivity for PC and may provide preliminary information for exploratory risk stratification in cytology-negative patients. Further external validation is required before PJ-CEA can be used to guide re-testing and surveillance strategies.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1018-1028"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-on-chronic liver failure following pneumonia in an elderly woman with metabolic dysfunction-associated steatotic liver cirrhosis.","authors":"Luyi Yao, Kunimichi Saeki, Akane Tange, Takahiro Chigira, Yasushi Ohnisi, Toshinori Takada, Tatsuo Kanda","doi":"10.1007/s12328-026-02419-9","DOIUrl":"10.1007/s12328-026-02419-9","url":null,"abstract":"<p><p>The number of patients with acute-on-chronic liver failure (ACLF) from metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing, and its aging cohort is experiencing increasing mortality. In general, it is more difficult to manage elderly patients with ACLF. Here, we described a case of prolonged ACLF triggered by pneumonia in a woman in her 80s who had MASLD-associated cirrhosis. Although she developed both spontaneous bacterial peritonitis and aspiration pneumonia during the course of her first admission to our department, she recovered with intensive care provision, including steroid treatment and antibiotics for acute respiratory failure. She was discharged from our hospital on Day 45. Age is one of the important factors influencing prognosis, indicating that elderly patient with ACLF seems to exhibit a poor prognosis. Her infection events were adequately controlled, which seemed to benefit for her survival. In conclusion, we confirm that appropriate treatments without liver transplantation may lead to a better prognosis in patients with ACLF, even among elderly patients.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1314-1319"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal primary hepatic epithelioid hemangioendothelioma: a case in which tumor biopsy was critical to prevent misdiagnosis.","authors":"Yuya Matsuo, Keisuke Nakanishi, Shinsaku Nagamatsu, Akane Kawasaki, Takuma Morimoto, Satoshi Watanabe, Takahiro Kubo, Masakazu Uejima, Kohei Morita, Kei Moriya","doi":"10.1007/s12328-026-02416-y","DOIUrl":"10.1007/s12328-026-02416-y","url":null,"abstract":"<p><p>Hepatic epithelioid hemangioendothelioma is rare, and because its imaging findings are nonspecific, pathological evaluation is essential for definitive diagnosis. In this 82‑year‑old woman, multiple hepatic masses were incidentally detected on contrast‑enhanced CT during postoperative surveillance for bladder cancer, and concurrent local recurrence made metastasis the leading suspicion. However, immunohistopathological examination of a liver biopsy excluded metastatic carcinoma and confirmed primary hepatic epithelioid hemangioendothelioma. She died of liver failure. This case underscores the need to consider diagnoses other than metastatic liver cancer and to perform an appropriate differential workup, even in patients with multiple hepatic lesions and a history of malignancy.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1300-1306"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sildenafil-associated severe cholestatic drug-induced liver injury presenting as persistent jaundice after stone extraction.","authors":"Yuma Kamijo, Takanobu Iwadare, Ryoko Endo, Minori Kamata, Kaede Fujita, Shunichi Wakabayashi, Hiroyuki Kobayashi, Tomoo Yamazaki, Takeshi Uehara, Takefumi Kimura","doi":"10.1007/s12328-026-02390-5","DOIUrl":"10.1007/s12328-026-02390-5","url":null,"abstract":"<p><strong>Background: </strong>Sildenafil is widely used as a phosphodiesterase type 5 inhibitor for erectile dysfunction. Drug-induced liver injury (DILI) associated with sildenafil is rare, with severe cholestatic cases remaining poorly characterized. A 43-year-old Japanese man was assigned to work in the Philippines two months before presentation and began regularly taking sildenafil (KAMAGRA®) obtained locally. One month before presentation, he developed abdominal pain and vomiting. Magnetic resonance imaging revealed choledocholithiasis, and endoscopic retrograde cholangiopancreatography with stone extraction was successfully performed. However, his severe jaundice persisted and progressively worsened. Upon returning to Japan for further evaluation, imaging studies showed no evidence of persistent biliary obstruction. Liver biopsy demonstrated marked canalicular cholestasis without bile duct destruction, which was inconsistent with prolonged obstructive jaundice. Causality assessment using revised electronic version of Roussel Uclaf Causality Assessment Method for the diagnosis of drug-induced liver injury-Japan, 2023 (RECAM-J 2023) yielded a score of 11 for sildenafil, indicating a highly probable association. After treatment with ursodeoxycholic acid and colestimide, his bilirubin levels gradually normalized.</p><p><strong>Conclusion: </strong>Sildenafil formulations obtained outside routine medical supervision may cause severe cholestatic DILI. Careful medication history taking and structured causality assessment are essential for an accurate diagnosis.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1228-1234"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenocarcinoma with enteroblastic differentiation with choriocarcinoma components arising in long-segment Barrett's esophagus: a report of autopsy case.","authors":"Yuki Sato, Tomio Arai, Kazushi Fukagawa, Yusuke Horikoshi, Kazushi Masatani, Shun Osumi, Shosuke Hosaka, Toshiyuki Ishiwata, Satoshi Ono","doi":"10.1007/s12328-026-02399-w","DOIUrl":"10.1007/s12328-026-02399-w","url":null,"abstract":"<p><p>Adenocarcinoma with enteroblastic differentiation (AED) commonly develops in the stomach but rarely occurs at the lower esophagus or esophagogastric junction. This tumor may combine with another subtype such as neuroendocrine carcinoma, conventional adenocarcinoma, and so on. An 87-year-old male patient was admitted to our hospital because of anorexia. Esophagogastroduodenoscopy performed to investigate the cause of anorexia revealed a nearly circumferential elevated lesion at the lower esophagus and esophagogastric junction. Biopsy results showed AED with small foci of choriocarcinoma components. A CT scan showed multiple liver metastases. The patient died 11 days after admission due to hematemesis and hypovolemic shock. Autopsy demonstrated hemorrhage from the tumor, and 700 mL of blood had accumulated in the stomach, being a direct cause of death. As long-segment of Barrett's esophagus (LSBE) was observed in the background of the tumor, the tumor was considered to originate from LSBE. The tumor also extended along the intraesophageal and azygos veins and metastasized to the liver and lung. These results suggest that a peculiar type of carcinoma with aggressive biological behavior occurs in the LSBE.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1092-1098"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous regression of colorectal liver metastasis with coexisting IgG4-rich inflammatory pseudotumor-like changes: a case report.","authors":"Shoichiro Mizukami, Tatsuya Shonaka, Tomoki Takizawa, Katsuro Enomoto, Hiroyuki Takahashi, Koji Imai, Yuki Kamikokura, Sayaka Yuzawa, Mishie Tanino, Hideki Yokoo","doi":"10.1007/s12328-026-02387-0","DOIUrl":"10.1007/s12328-026-02387-0","url":null,"abstract":"<p><p>Spontaneous regression of colorectal liver metastasis (CRLM) is an extremely rare phenomenon with only a few reported cases. However, the underlying mechanism remains unclear. Infection-triggered immune reactivation and inflammation have also been proposed to be potential contributors. IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition characterized by IgG4-positive plasma cell infiltration and fibrosis, and rarely manifests in the liver as an inflammatory pseudotumor (IPT). We herein report a rare case of a 71-year-old man with possible spontaneous regression of CRLM accompanied by coexisting IgG4-rich IPT-like changes. Eight months after the laparoscopic Hartmann's operation for rectal cancer, imaging revealed hepatic lesions in segments S5 and S7, which were diagnosed as CRLM. Partial hepatectomy revealed necrotic adenocarcinoma in the S7 lesion, with IgG4-rich IPT-like inflammatory changes. Postoperative evaluation revealed markedly elevated serum IgG4 levels and IgG4-positive plasma cell infiltration in the mediastinal lymph nodes, fulfilling the diagnostic criteria for systemic IgG4-RD. Twenty months postoperatively, the patient remained recurrence-free without adjuvant chemotherapy or steroid therapy. This case report describes the coexistence of spontaneous tumor regression and IgG4-related hepatic IPT within the same lesion and provides insight into the clinicopathological spectrum linking tumor regression and IgG4-RD.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1053-1062"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of esophageal perforation associated with pharyngotonsillitis and Streptococcus anginosus group infection.","authors":"Narumi Deguchi, Masatoshi Nakagawa, Noboru Inoue, Shuhei Takise, Masanobu Nakajima, Shinji Morita, Akihiro Kawabe, Hadzki Matsuda, Kazuyuki Ishida, Kazuyuki Kojima","doi":"10.1007/s12328-026-02396-z","DOIUrl":"10.1007/s12328-026-02396-z","url":null,"abstract":"<p><strong>Background: </strong>Esophageal perforation is most commonly caused by foreign body ingestion, medical procedures, or spontaneous rupture. In contrast, perforation secondary to bacterial infection is extremely rare, particularly in immunocompetent individuals.</p><p><strong>Case presentation: </strong>A previously healthy 60-year-old man developed pharyngotonsillitis followed by progressive right-sided chest pain. Initial chest radiography showed no abnormalities; however, subsequent computed tomography performed after clinical deterioration revealed right-sided empyema and an intramural abscess of the esophageal wall. Despite chest drainage and broad-spectrum antibiotics, the patient's respiratory status worsened, necessitating transfer to our hospital. Upper gastrointestinal endoscopy demonstrated extensive circumferential esophageal ulceration with purulent discharge. Streptococcus constellatus, a member of the Streptococcus anginosus group, was isolated from pleural fluid cultures. Because of severe infection, extensive empyema, and marked fragility of the esophageal wall, thoracoscopic total thoracic esophagectomy with a two-stage reconstruction strategy was performed. The postoperative course was favorable, and delayed reconstruction using a gastric conduit was successfully completed.</p><p><strong>Conclusion: </strong>This case suggests that streptococcal pharyngotonsillitis may be associated with life-threatening esophageal perforation and empyema even in immunocompetent patients. Early recognition of disease progression and timely surgical intervention are essential in severe infectious cases.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1082-1086"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between autoimmune pancreatitis and pancreatic cancer: a case after long-term steroid therapy.","authors":"Ryogo Minami, Jun Nakahodo, Shinichiro Horiguchi, Masataka Kikuyama, Makoto Saitou, Ayu Tachibana, Kazuro Chiba, Hiroki Tabata, Wataru Ujita, Terumi Kamisawa","doi":"10.1007/s12328-026-02398-x","DOIUrl":"10.1007/s12328-026-02398-x","url":null,"abstract":"<p><p>Autoimmune pancreatitis is a rare immunoglobulin G4-related disease characterized by a favorable response to steroids. However, its association with pancreatic cancer remains unclear. We report the case of a 71-year-old male who developed pancreatic cancer 1 month after completing a 7-year course of steroid therapy for autoimmune pancreatitis. Initially diagnosed based on elevated serum immunoglobulin G4 levels and characteristic imaging findings, the patient's autoimmune pancreatitis remained in remission during steroid therapy. Post-treatment imaging, positron emission tomography revealed a pancreatic tail mass leading to the differential diagnosis of autoimmune pancreatitis relapse versus pancreatic cancer. Histopathological examination confirmed adenocarcinoma, and the patient underwent successful neoadjuvant chemoradiotherapy and surgical resection. This case highlights the diagnostic challenges in distinguishing autoimmune pancreatitis from pancreatic cancer and emphasizes the importance of vigilant and long-term surveillance of patients with autoimmune pancreatitis, even in those with prolonged remission. Advanced imaging modalities and histopathological confirmation are essential for timely and accurate diagnosis.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1241-1249"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}